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Jackson
![Brian R. Jackson, MD, MS Brian R. Jackson, MD, MS](/sites/default/files/Jackson.jpg)
Bartonella species bacteria cause a range of diseases, including cat scratch disease (CSD), caused by B. henselae; trench fever, caused by B. quintana; Carrión disease (Oroya fever and verruga peruana), caused by B. bacilliformis; and bacillary angiomatosis (BA), caused by B. henselae and B. quintana. 1 Centers for Disease Control and Prevention. Bartonella infection: about Bartonella. Last reviewed: May 2024; accessed Oct 2024. Centers for Disease Control and Prevention. Bartonella infection: clinical guidance for Bartonella bacilliformis. Last reviewed May 2024; accessed Oct 2024. Centers for Disease Control and Prevention. Bartonella infection: clinical guidance for Bartonella henselae. Last reviewed May 2024; accessed Oct 2024. Centers for Disease Control and Prevention. Bartonella infection: clinical guidance for Bartonella quintana. Last reviewed May 2024; accessed Oct 2024. Centers for Disease Control and Prevention. Bartonella infection: about Bartonella. Last reviewed: May 2024; accessed Oct 2024. Centers for Disease Control and Prevention. Bartonella infection: clinical guidance for Bartonella bacilliformis. Last reviewed May 2024; accessed Oct 2024. Centers for Disease Control and Prevention. Bartonella infection: clinical guidance for Bartonella henselae. Last reviewed May 2024; accessed Oct 2024. Centers for Disease Control and Prevention. Bartonella infection: clinical guidance for Bartonella quintana. Last reviewed May 2024; accessed Oct 2024.
Quick Answers for Clinicians
Cat scratch disease (CSD) is transmitted through the scratch of domestic or feral cats carrying fleas infected with Bartonella henselae. Diagnostic testing for CSD may be appropriate for patients exhibiting CSD symptoms with previous exposure to cats and recent scratch history. Trench fever is transmitted by the human body louse. Testing for trench fever may be appropriate in patients with characteristic symptoms who are at an increased risk for human body lice (eg, persons experiencing homelessness or living in areas with poor sanitation). Carrión disease is transmitted through female sand flies, primarily in high-elevation areas of the Andes Mountains, and should be considered in patients who have traveled to that region or have been in contact with someone who has traveled to that region. 1 Centers for Disease Control and Prevention. Bartonella infection: about Bartonella. Last reviewed: May 2024; accessed Oct 2024.
Cat scratch disease (CSD) is often characterized by low-grade fever, enlarged and/or tender lymph nodes (1-3 weeks postexposure), and a papule or pustule at the scratch site. In some cases, infection may develop in the bones, eyes, brain, liver, heart, or spleen. Trench fever generally presents with fever (one time or relapsing), headache, rash, and bone pain. Carrión disease occurs in two distinct phases. The first, Oroya fever, may include symptoms such as fever, headache, muscle aches, and abdominal pain. The second phase, verruga peruana (Peruvian warts), is characterized by the formation of growths under the skin that develop into red to purple vascular sores. Bacillary angiomatosis (BA) occurs most frequently in people with weakened immune systems (eg, patients with advanced HIV infection) and may result in fever, bone pain, or lesions of the skin, bone, or other organs. 1 Centers for Disease Control and Prevention. Bartonella infection: about Bartonella. Last reviewed: May 2024; accessed Oct 2024.
Because Bartonella symptoms are often generalized, the testing strategy should also be informed by patient history.
Indications for Testing
Testing for Bartonella species is appropriate in patients with a compatible exposure history and typical signs and symptoms of CSD, trench fever, Carrión disease, BA, or subacute endocarditis.
Laboratory Testing
The laboratory diagnosis of Bartonella infection generally includes serology, NAAT, and culture. The laboratory testing strategy depends on the suspected etiology of disease. 2 Centers for Disease Control and Prevention. Bartonella infection: clinical guidance for Bartonella bacilliformis. Last reviewed May 2024; accessed Oct 2024. Centers for Disease Control and Prevention. Bartonella infection: clinical guidance for Bartonella henselae. Last reviewed May 2024; accessed Oct 2024. Centers for Disease Control and Prevention. Bartonella infection: clinical guidance for Bartonella quintana. Last reviewed May 2024; accessed Oct 2024.
Serology
Serology may be useful to confirm diagnosis of CSD and trench fever, including current and past exposure to Bartonella spp. Low sensitivity and cross-reactivity between Bartonella spp may complicate diagnosis in some cases. 3 Centers for Disease Control and Prevention. Bartonella infection: clinical guidance for Bartonella henselae. Last reviewed May 2024; accessed Oct 2024. Centers for Disease Control and Prevention. Bartonella infection: clinical guidance for Bartonella quintana. Last reviewed May 2024; accessed Oct 2024. Centers for Disease Control and Prevention. Bartonella infection: clinical guidance for Bartonella henselae. Last reviewed May 2024; accessed Oct 2024. Centers for Disease Control and Prevention. Bartonella infection: clinical guidance for Bartonella quintana. Last reviewed May 2024; accessed Oct 2024. Crump JA, Corder JR, Henshaw NG, et al. Development, implementation, and impact of acceptability criteria for serologic tests for infectious diseases. J Clin Microbiol. 2004;42(2):881-883.
Polymerase Chain Reaction Testing
Polymerase chain reaction (PCR) testing may be useful for the diagnosis of CSD, trench fever, and BA, including in patients with culture-negative endocarditis. PCR assays are generally appropriate for tissue or blood samples. The sensitivity of molecular testing is often low in blood samples. Other specimen types may be appropriate under specific circumstances. Patients undergoing valvular replacement should be tested via PCR using heart valve tissue. 3 Centers for Disease Control and Prevention. Bartonella infection: clinical guidance for Bartonella henselae. Last reviewed May 2024; accessed Oct 2024. Centers for Disease Control and Prevention. Bartonella infection: clinical guidance for Bartonella quintana. Last reviewed May 2024; accessed Oct 2024. Centers for Disease Control and Prevention. Bartonella infection: clinical guidance for Bartonella henselae. Last reviewed May 2024; accessed Oct 2024.
Many PCR assays do not differentiate between Bartonella spp, which might complicate treatment selection. The sensitivity of molecular testing decreases as time from the initial infection increases.
Culture
Bartonella culture can be technically challenging and requires at least 21 days of incubation. Blood or tissue culture may be useful for the diagnosis of CSD, trench fever, Carrión disease, and subacute endocarditis. 2 Centers for Disease Control and Prevention. Bartonella infection: clinical guidance for Bartonella bacilliformis. Last reviewed May 2024; accessed Oct 2024. Centers for Disease Control and Prevention. Bartonella infection: clinical guidance for Bartonella henselae. Last reviewed May 2024; accessed Oct 2024. Centers for Disease Control and Prevention. Bartonella infection: clinical guidance for Bartonella quintana. Last reviewed May 2024; accessed Oct 2024.
Other Testing
A peripheral blood smear can be used to diagnose Carrión disease during the Oroya fever phase. 2 Centers for Disease Control and Prevention. Bartonella infection: clinical guidance for Bartonella bacilliformis. Last reviewed May 2024; accessed Oct 2024.
ARUP Laboratory Tests
Semi-Quantitative Indirect Fluorescent Antibody (IFA)
Qualitative Polymerase Chain Reaction
References
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CDC - Bartonella infection-about
Centers for Disease Control and Prevention. Bartonella infection: about Bartonella. Last reviewed: May 2024; accessed Oct 2024.
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CDC - Bartonella infection-clinical guidance-B bacilliformis
Centers for Disease Control and Prevention. Bartonella infection: clinical guidance for Bartonella bacilliformis. Last reviewed May 2024; accessed Oct 2024.
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CDC - Bartonella infection-clinical guidance-B henselae
Centers for Disease Control and Prevention. Bartonella infection: clinical guidance for Bartonella henselae. Last reviewed May 2024; accessed Oct 2024.
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CDC - Bartonella infection-clinical guidance-B quintana
Centers for Disease Control and Prevention. Bartonella infection: clinical guidance for Bartonella quintana. Last reviewed May 2024; accessed Oct 2024.
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Crump JA, Corder JR, Henshaw NG, et al. Development, implementation, and impact of acceptability criteria for serologic tests for infectious diseases. J Clin Microbiol. 2004;42(2):881-883.